Cartotto Robert, Walia Gautam, Ellis Sandi, Fowler Rob
The Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
J Burn Care Res. 2009 Jan-Feb;30(1):119-27. doi: 10.1097/BCR.0b013e3181920fe6.
The purpose of this study was to evaluate the effectiveness of, and complications associated with High Frequency Oscillatory Ventilation (HFOV) in burn patients with the Acute Respiratory Distress Syndrome (ARDS) who have had a smoke inhalation injury, and to compare with those without an inhalation injury. Burn patients with progressive oxygenation failure from ARDS while on conventional mechanical ventilation were placed on HFOV as a "rescue" ventilation modality. There were 19 patients with burn + inhalation injury and 30 patients with burn only. Burned patients with ARDS but without inhalation injury had significant temporal improvement in the oxygenation index from 27 +/- 8 on conventional mechanical ventilation to 17 +/- 6 within 48 hours of initiating HFOV. However, burned patients with ARDS and smoke inhalation injury did not achieve significant or even eventual improvements in oxygenation index with HFOV. There was also a trend towards higher rates of early HFOV failure and severe hypercapnia while on HFOV among the patients with inhalation injury. Delivery of nebulized bronchodilators, heparin and n-acetyl cysteine, normally mainstays of smoke inhalation therapy, was impossible during HFOV. The presence of a smoke inhalation injury appears to impair the response to HFOV when this ventilation modality is instituted for ARDS-related oxygenation failure. Severe hypercapnia tended to be more frequent during HFOV among patients with smoke inhalation. These findings, combined with the difficulties in delivery of nebulized medications during HFOV suggest that HFOV may not be the optimal "rescue" ventilation modality in cases of ARDS if there has been an inhalation injury.
本研究的目的是评估高频振荡通气（HFOV）对合并烟雾吸入性损伤的急性呼吸窘迫综合征（ARDS）烧伤患者的有效性及相关并发症，并与未发生吸入性损伤的患者进行比较。因ARDS导致常规机械通气时氧合功能进行性衰竭的烧伤患者被采用HFOV作为“挽救”通气模式。其中19例为烧伤合并吸入性损伤患者，30例为单纯烧伤患者。ARDS但无吸入性损伤的烧伤患者在开始HFOV后48小时内氧合指数有显著改善，从常规机械通气时的27±8改善至17±6。然而，ARDS合并烟雾吸入性损伤的烧伤患者采用HFOV后氧合指数未取得显著甚至最终改善。吸入性损伤患者在HFOV期间早期HFOV失败率和严重高碳酸血症发生率也有升高趋势。在HFOV期间无法给予雾化支气管扩张剂、肝素和N-乙酰半胱氨酸，而这些通常是烟雾吸入治疗的主要手段。当针对ARDS相关氧合衰竭采用这种通气模式时，烟雾吸入性损伤的存在似乎会损害对HFOV的反应。烟雾吸入患者在HFOV期间严重高碳酸血症往往更常见。这些发现，再加上HFOV期间雾化药物给药困难，表明如果存在吸入性损伤，HFOV可能不是ARDS病例的最佳“挽救”通气模式。
